Sexuality & Intimacy in Aged Care

elderly couple in bed

Massey University Professor of Social Work Mark Henrickson has published a report on a three-year nationwide research project into intimacy and sexuality in residential aged care facilities to support and develop awareness, policies and education for staff, families and residents.

Professor Mark Henrickson found that while there is excellent work being done in some care facilities, there is a lot of room for regular staff education around intimacy and sexuality. Staff education and workplace policies could help bring consistency in addressing the issue.

"When there is insufficient staff education, people rely on their values and beliefs. Some of these beliefs are open to being influenced by religious attitudes, which can create challenges in the workplace," he said.

The call for action began more than ten years ago when Professor Henrickson would present to care providers about sexuality. Each time he was approached by staff voicing their concerns about responding to situations. Including residents being allowed in a room alone to engage in sexual activity or residents having access to sex workers.

"There were so many difficult and complicated stories people were telling me. I realised what we need is the solid foundation of research in this area to throw some light on these complex issues," Professor Henrickson said.

At one facility a pilot study was followed up by a feasibility study that included five facilities. Funding by the Royal Society of New Zealand’s annual Marsden Fund allowed the team’s research to continue at a national level. Professor Henrickson, joined Dr Catherine Cook, Dr Vanessa Schouten, Sandra McDonald, Ngāti Whātua, Te Uri o Hau, and project manager Dr Nilo Atefi. Local 'ambassadors' also researched their regions to provide national coverage.

The study was conducted in two parts, at 35 facilities nationwide. The team sent part one to staff at participating facilities. It included questions regarding knowledge, attitudes, and behaviour around sexuality with 433 forms completed and returned.

The survey questions investigated the reliance on personal values for decision-makers about sexual issues in the workplace; attitudes towards patients with dementia engaging in sexual activity; and consent and casual sexual relationships within aged care facilities.

The second part of the study involved semi-structured interviews conducted by the project staff with staff, residents, and family members. Altogether, 61 interviews were completed with 75 participants across the facilities, some ranging from a few minutes up to several hours over two days.

"Hearing the richness of people's lives and how they managed their relationships in the third age was touching and reassuring," Professor Henrickson said.

"The results show that people are widely varied in their attitudes, meaning that the sector needs some decision making on the topics alongside better staff education.

"It is impossible to write a set of laws, policies, rules, and regulations that will cover every possible eventuality for every kind of person in every place.

“The decision-making framework is not set up to encourage individual staff to assess and make rapid decisions in situations that may not be clear. As a result, staff make decisions that are better suited to protecting institutions and institutional reputations than to provide meaningful protection for residents."

Professor Henrickson said it might be, for instance, that a resident with intellectual impairment may not be able to verbally articulate consent, but is clearly enjoying a moment of intimacy with a partner.

“But if someone has decided that an individual is not able to make decisions for themselves, they may interfere unnecessarily at that moment.

"These decisions will certainly affect a resident's quality of life and their ability to live life fully."

The research has revealed a generational effect on attitudes towards same-sex sexuality. Among older New Zealand-born survey respondents (those whose attitudes were likely to be formed before the Homosexual Law Reform Act in 1986), there was less support for same-sex relationships.  Younger respondents attitudes may be influenced by an era of greater social acceptance, visibility of gender diversity and sexual diversity, and marriage equality.

"We would advise facilities to create workplace policies that, regardless of what people's attitudes are, regardless of their behaviour, what people see at least is consistent in every workplace.

"For example, we're not saying that every facility should provide access to sex workers, but that they should have policies or guidelines about this, for consistency. Educate staff about those policies.”

Further, residents and family members should know about those policies when they make choices about long-term residential care.

"Each facility will have individual challenges. It is not just about intimate engagements; it is also about the legal, moral, and ethical implications that come with these engagements.

"This project is about tackling those issues. One of the things we're saying is if you get it right on sex, you'll get it right on just about everything else."

Over the past few months, Professor Henrickson and his team have been working with facilities to break the taboo nature of the subject and prompt educators to take a new approach. Some facilities have begun producing podcasts, training videos and other resources to educate their staff.

From the information collated the team then detailed their findings into a final project report What counts as consent? Sexuality and ethical deliberation in residential aged care, a resource he hopes the sector takes seriously.

"This report may be confronting for some facilities, which would be unfortunate as we're not telling people what's right and what's wrong, but rather that these challenges are already here. To take them seriously means you're going to improve your care for all your residents and help your staff feel more confident in the workplace."

The full report can be found here.